Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, Australia.
Neonatal Directorate, Perth Children's Hospital, Perth, Australia.
J Neonatal Perinatal Med. 2021;14(1):9-19. doi: 10.3233/NPM-190366.
To compare outcomes of hospitalized preterm infants following previable prelabour rupture of membranes (PPROM) at≤23 weeks of gestation.
Retrospective cohort study of preterm infants admitted for intensive care, between January 2006 and December 2016 following PPROM, was conducted. Short term clinical outcomes included severity of respiratory morbidity, length of hospital stay and mortality. Neurodevelopment in survivors was assessed using Bayley's Scales of Infant Development (3rd edition) at 24 months corrected age.
A total of 82 preterm infants were admitted following PPROM at < 23 weeks and were grouped as: Group 1 (n = 28) with PPROM < 20 weeks and Group 2 (n = 54) with PPROM between 20-22 + 6 weeks. Median latency following PPROM was significantly longer in Group 1 infants [69(Interquartile range (IQR): 43-74; Range (R): 25-100 vs. 29(IQR: 10-53; R: 2-72) days, p < 0.001]. Median gestation at delivery was 27.4 weeks (Group 1) vs. 25.1 weeks (Group 2). Group 1 had a significantly higher incidence of oligohydramnios [13(46.4%) vs. 8(14.8%), p = 0.002], lower Apgar scores (<7) at 5 minutes [19(67.9%) vs. 24(44.4%), p = 0.044], increased pulmonary hypoplasia [13(46.4%) vs. 5(9.3%), p < 0.001], joint contractures [3(10.7%) vs. 0, p = 0.037] and mortality [10(35.7%) vs. 7(13.0%), p = 0.016]. Neurodevelopmental outcomes at 24 months corrected age were comparable in the 36 surviving infants (9/18 vs. 27/547).
Morbidity and mortality is high in infants born after previable PPROM; specifically, in those with PPROM < 20 weeks although early childhood neurodevelopmental outcomes were comparable. Larger prospective studies focussing on long term neonatal outcomes are needed to confirm these findings.
比较极早早产儿胎膜早破（PPROM）发生在 23 周前时的住院结局。
回顾性队列研究纳入 2006 年 1 月至 2016 年 12 月期间因 PPROM 入住重症监护病房的极早早产儿。短期临床结局包括呼吸窘迫严重程度、住院时间和死亡率。幸存者的神经发育通过贝利婴幼儿发育量表（第 3 版）在 24 个月校正年龄时进行评估。
共有 82 例极早早产儿因 23 周前的 PPROM 入院，并分为：组 1（n=28）PPROM<20 周和组 2（n=54）PPROM 在 20-22+6 周。组 1 婴儿的 PPROM 后潜伏期明显更长[69（四分位距（IQR）：43-74；范围（R）：25-100 与 29（IQR：10-53；R：2-72）天，p<0.001]。分娩时的中位胎龄为 27.4 周（组 1）和 25.1 周（组 2）。组 1 羊水过少的发生率明显更高[13（46.4%）与 8（14.8%），p=0.002]，5 分钟时 Apgar 评分<7 的比例更高[19（67.9%）与 24（44.4%），p=0.044]，肺发育不良发生率更高[13（46.4%）与 5（9.3%），p<0.001]，关节挛缩发生率更高[3（10.7%）与 0，p=0.037]，死亡率更高[10（35.7%）与 7（13.0%），p=0.016]。36 例幸存婴儿（18 例中有 9 例）24 个月校正年龄时的神经发育结局相当（54 例中有 27 例）。
极早早产儿发生极早早产胎膜早破后发病率和死亡率高；特别是那些发生在 20 周前的 PPROM，尽管其婴幼儿早期神经发育结局相当。需要更大规模的前瞻性研究来确定这些发现。
